Knowledge and Factors Influencing Health Seeking Behaviour Among Women Attending Antenatal Health Clinic in Alimosho Primary Health Centres in Alimosho, Lagos State Nigeria
CHAPTER ONE
Purpose of the study
The main purpose for establishing this study is to examine the knowledge and factors influencing health seeking behaviour among women attending antenatal health clinic in Alimosho Primary Health Centres in Alimosho, Lagos State Nigeria. Specifically, the study sought to:
- Examine the association between economic factors and antenatal health seeking behaviour.
- Assess the association between socio-cultural factors and antenatal health seeking behaviour.
- Examine the institutional factors and their impact on antenatal health seeking behaviour of these mothers.
- Determine the association between psychological factors and the antenatal health seeking behaviour of woman
- Establish the knowledge, attitude and practice of women towards antenatal health seeking behaviour.
CHAPTER TWO
LITERATURE REVIEW
Introduction
The problem of women’s pregnancy and poor prenatal health care seeking behavior is increasingly recognized as a major concern confronting contemporary civilization and a serious threat to the MDGs. Despite an increase in programmatic research interest in addressing the needs of pregnant women, the specific requirements of pregnant women have been poorly addressed and recorded (WHO, 2017). However, studies have been conducted in many regions of the globe to assess these young women’s prenatal health care seeking behavior, and several problems have been identified. Despite the obstacles given by the various changes in women, according to Atchessi et al. (2018), it is a period when they are intended to shape their behaviors via programs that may teach them essential skills to cope with health concerns, one of which is prenatal health care.
The emphasis of the literature review will be on women’s pregnancy in connection to antennal care as defined by WHO, the relevance of prenatal health care, pregnant women’s antenatal health seeking behavior, and the variables that influence this behavior. It will also draw attention to any gaps in previous research.
CHAPTER THREE
METHODOLOGY
Study Design
Wright et al., (2016) described research design as “the overall strategy for conducting research that defines a concise and logical plan to address established research questions through the collection, interpretation, analysis, and discussion of data”. The study research design describes the type of research used, hypotheses, research problem, dependent and independent variable (Creswell, 2012). This was a descriptive cross-sectional quantitative and qualitative study to establish knowledge and factors influencing health seeking behaviour among women attending antenatal health clinic. The descriptive research design is used to systematically and accurately describe the characteristics of a study population (Diekmann, 2019). The descriptive research design was used because the study relied majorly on primary data collected from sampled respondents.
Study Population
The population of the study is the total number of individuals from whom the study data was gathered in the study area (Adèr et al. 2018). The study population included pregnant women attending antenatal health care in Alimosho Primary Health Centres in Alimosho.
CHAPTER FOUR
RESULTS
Introduction
This chapter summarizes the findings of the study’s quantitative and qualitative data. The research included 72 pregnant women from Alimosho Primary Health Centres and the Alimosho Antenatal Health Clinic. The 72 surveys received were completely filled out, resulting in a 100% response rate. The study’s major goal was to determine the knowledge and variables that influence women’s health-seeking behavior in prenatal health clinics.
The findings of descriptive and inferential statistics have been given.
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
Introduction
This chapter presents a discussion of the main findings of the study on knowledge and factors influencing health seeking behaviour among women attending antenatal health clinic in Alimosho Primary Health Centres in Alimosho. Conclusions are drawn and recommendations made based on the study findings.
Discussion of the findings
Participants Demographic Factors
The demographic factors cited in this study included age, marital status, place of residence, educational status, and previous parity.
The major age was the age group of 25 – 30 with a total of 41 (57.0%) of the respondents. This It is the period when the body takes a more distinct adult form. However, decision making and negotiation skills necessary to make informed choices and resist pressure to engage in irresponsible sexual behaviour is still lacking (Ministry of Health, 2015).
This age group is in consistent with Latunji & Akinyemi (2018), who in his study in Uganda, established that a quarter to a half of women have their first child between 25 – 30 years of age. This corresponds to the range and median age in this study.
A high percentage of study participants (51%) were married, not because of mature marriage age, but mainly due to economic frustrations. 18% of the respondents were not educated, while 31% had completed secondary school. This showed a low level of education attainment among the respondents. Therefore, they were not fully equipped for the job market. Most of them were not employed (51%), against only 49% that were employed. This explains why only 19% of the study participants are employed in low grade jobs like house help, restaurant attendant and salonist. This is in consonant with the findings of Hassan & Basirka (2021), which established that young maternal age and low educational levels generally describe women receiving little or no antenatal health care.
It states that women pregnancy corresponds with social indicators such as low level of education and early age at marriage. This study is in strong support of this perception based on the low education levels established in these young participants.
Prevalence of women Seeking Quality Antenatal Care.
The prevalence of women seeking quality antenatal care among the study participants was very low. Only 30.6% (n=22) of all study participants had positive health seeking behaviour. This is consistent with WHO (2016) perception on utilization of antenatal care services by women. This established that it is usually insufficient.
Even though many participants preferred services from modern health personnel, and made an effort to walk to the clinic when they had no transport, many never took the initial decision to come to the clinic. This made them start clinics late. Other socio-cultural and economic factors also compromised their power to make decisions.
It was noted that 72.2% of the respondents did not start antenatal health care in the first trimester. Many (39) reported that they had no knowledge, 15 complained of financial constraints, 14 were either afraid or ashamed to come and the others were in school at the time when they realized they were pregnant. These findings are consistent with those in Bouzid et al. (2018) and Latunji & Akinyemi (2018) studies. They found that women usually started clinics late.
Victims of women pregnancy are usually not aware of the School Health Policy governing such pregnancies. The policy states that, when these young mothers fall victims of unplanned pregnancies “both the students and their parents shall be counselled on the importance of ensuring a good outcome of the pregnancy by attending antenatal health care. The student should be supported to start antenatal health care. The school nurse should advise the student to make at least four antenatal health care visits.” (School Health Policy 2019).
Most of the participants stated that they left school even without their parents or school nurse knowing. Some, even in the third trimester, claimed that their parents were not aware of their situation, so they could only trick them to get money for antenatal health care.
Demographic Factors and Antenatal Health seeking behaviour
The ages of the respondents did not show any statistical association with positive health seeking behaviour. However, as cited by Bouzid et al. (2018), younger maternal age was associated with reception of little care. This was due to the fact that most of them were unable to make decisions for themselves. For instance, only 26.8% decided on their own to attend antenatal health care. Most were decided for by parents; they stated that they were either afraid or ashamed.
In contrast to Adenkale et al. (2018) study results, employed women had more negative health seeking behaviour than the unemployed. This was probably due to the fact that most of them were doing low grade jobs like restaurant attendant, house help and shop keepers. Consequently, most of them were not easily released from work.
Town dwellers appeared to be more informed than rural ones on health issues. This, and the proximity of the facility, might have made them to be more in this study. However, the difference was not significant.
These findings tie well with Adekanle et al. (2018) study. In their study on late antenatal care booking and its predictors in South Western Nigeria, they established that the factors stated above were responsible for late entry to antenatal health care.
Economic Factors
In line with Bouzid et al. (2018) findings, the majority of study participants were not enrolled in any insurance (93%). Most of those with no health insurance tended to show more negative health seeking behaviour (70.1%) than those who were insured (60%). Many cited financial compromises (38.9%) as a cause of no insurance. A large number said they had never heard of insurance (38.9%).
Those who reported they struggle to get money had more negative health seeking behaviour than those who had not struggled (72.2% as opposed to 66.7%). This shows that favourable economic conditions tend to promote positive health seeking behaviour. Studies in Nigeria have also shown that cost of services hinders a significant number of young people from seeking health care. The studies indicated that most of them are usually in school and only dependent on parents or guardians to meet their health care costs (Ministry of Health, 2015).
These findings compare well with Mbouzeko (2019) results. In his study in Cameroon, he established that poverty was a major contributing factor in receiving little or no care. Many subjects in this study confirmed that they either postponed their appointment or started late when they did not have money.
Noted was that the cost of antenatal health care services is relatively low, yet these young mothers were still unable to afford it. It is clearly stated in National Policy for Provision of YFS that “youth friendly delivery sites should work out systems whereby costs are waived/subsidized for young people who are too poor to pay” (Ministry of Health, 2015). Unfortunately, this system is not in place on the ground.
In contrast to Sinai et al. (2017) study, these study participants did not take the option of choosing charlatans and traditional providers despite their economic status. Despite their negative antenatal health seeking behaviour, they still made the choice for modern medical personnel care. They reasoned that they were well trained and knew what to do.
This study did not establish distance from service delivery point as a serious factor. Most of the respondents were near the facility (58%). These reported they took less than 30 minutes to reach the facility, 32% said they took 1-2 hours while only 10% took more than 3 hours. A small number said that they do miss appointments when they ca not trek long distances.
Socio-Cultural Factors
Socio-cultural factors have been shown to have significant influence on antenatal health seeking behaviour. Consistent with Hassan & Basirka (2021) findings, the respondents who did not plan for pregnancy recorded the highest negative antenatal health seeking behaviour (Chi square =3.927, p-value of 0.048). Most of these mothers said that they would have preferred to have the pregnancy later. The reasons they gave for this was that they were not yet married, were not financially equipped, had not finished education and would have liked to avoid shame. These reasons most likely contributed to their negative antenatal seeking behaviour.
In contrast to the findings of Latunji & Akinyemi (2018) in his study in Uganda, this study showed no relationship between established cultural beliefs and antenatal seeking behaviour. This is possibly because most of the subjects were not aware of existing beliefs.
However, the study demonstrated an association between other socio-cultural factors and antenatal health seeking behaviour. For instance, in cases where community members regarded pregnancy as a blessing and where family support was positive, there was more positive health seeking behaviour. This was consistent with the findings of Adekanle et al. (2018) in Western Nigeria.
Institutional Factors
This study showed no significant association between institutional factors and health seeking behaviour. However, it demonstrated a negative impact of health workers attitude on antenatal health seeking behaviour. Consistent with Latunji & Akinyemi (2018) findings, respondents who reported the attitude of health care workers as either intimidating or poor tended to show a very negative health seeking behaviour. This was unlike those who reported it as good.
Most of the subjects had no problems with the time spent at the facility. This is because most of them lived with parents and had no responsibilities. All who are employed however complained about the time and feared losing their jobs or customers due to undue delay.
In contrast to the findings of Yaya et al. (2017), (66.7%) of the respondents who said they were not satisfied with care instead demonstrated positive health seeking behaviour as opposed to those who said they were satisfied with care (20%). Those who were not satisfied with care expressed that they ‘just have to come because it is important for them and the baby”. What is more, contrary to Adekanle et al. (2018) findings, respondents who had heard negative comments from elderly women and friends showed more positive antenatal health seeking behaviour. These also saw a need for care for the sake of their health and that of the baby and therefore ignored the comments.
Some women develop positive health seeking behaviour in spite of the many confounding factors. Reasons for this were established through probing question.
When asked what health workers did that made them want to come back to Clinic, they gave varied reasons including offer of good services, encouragement and giving of good advice, education, polite service providers’ attitude and availability. These they said could also enable other women who stayed away to come for antenatal health care.
They likewise named what health workers did which could make them and other women not come to the clinic. The following were some of the things cited; slow services, poor services, they are rude, abuse mothers, lack of privacy and drugs not often available.
Conclusion
This study has established that the prevalence of women with positive antenatal health seeking behaviour is very low (30.6%). There is a significant association between unplanned pregnancy, peer influence and health seeking behaviour (p-value, 0.048, 0.007).
All the factors in the study had an impact on antenatal health seeking behaviour of these mothers even though in varying degrees. This study revealed that better financial status, marital status, education, attitude of health care workers and family support were some of the factors determining positive health seeking behaviour. Lack of knowledge and peer influence contributes highly to poor Antenatal health seeking behaviour.
Recommendations
Based on the findings of the study, the following recommendations are made:
- Alimosho Primary Health Centres in Alimosho should re-enforce community outreach and education at all levels through the media, posters and direct communication.
- There is need to re-enforce antenatal health care issues in existing policies like National school health policy and Women Reproductive health Policy.
- Youth friendly services and peer education should be re-enforced at all levels.
- More emphases should be put on insurance schemes and its awareness increased.
- The study could be expanded to include pregnant women who do not come to the facility. This would be made possible by community-based studies.
Contribution to knowledge
The findings from this study will add on existing knowledge related to the factors influencing health seeking behaviors among women attending antenatal care, which the educational curriculum designers may utilize the study findings in policy formulations and curriculum development.
Practice.
The findings from this study may be utilized to influence health workers attitudes so as to develop a positive attitude towards health care seekers hence their practice appreciated.
Research.
The findings from this study may be utilized by other nursing researchers as part of their literature review and recommendations being a basis for further research.
Suggestions for further study
The following areas were recommended for further research
- Similar study should be carried out in other States of the Federation.
- Study should be conducted on the influence of health system staff on maternal health care seeking behaviour and pregnancy outcome.
- Study should be carried out to find out why some women do not attend antenatal care despite the free maternal health care services provided by the government of Lagos State.
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